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General NPI Number Information
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NPI Number | 1720942998
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Entity Type | Individual
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Provider Name | MADISON ELIZABETH CLARK MSW, LSW
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Gender | Female
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Dates
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Enumeration Date | 12/12/2025
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 1990 W 3RD ST
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-7808
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Country | US
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Telephone | 570-320-2816
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Fax | 570-320-0201
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Provider Business Mailing Address
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Address Line | 511 TOFTREES AVE APT 207
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City | STATE COLLEGE
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State | PA
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Zip | 16803-1962
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Country | US
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Telephone | 919-995-7192
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW143752
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License Number State | PA
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